Joslin's Diabetes Deskbook, A Guide for Primary Care Providers, Updated 2nd Ed., Excerpt 2: Do You Know the Conditions that May Cause Inaccurate Results from the A1C Test?

Joslin's Diabetes Deskbook, A Guide for Primary Care Providers, Updated 2nd Ed., Excerpt 2: Do You Know the Conditions that May Cause Inaccurate Results from the A1C Test?
By Richard S. Beaser, M.D.


"... With respect to the testing methodology, when HPLC laboratory techniques are used to perform measurements, the number of things that can affect the test results is limited. Using this methodology, the most common factors that can affect A1C measurements are:

• Hemolytic anemias Carbamylated and acetylated hemoglobins (rare).
• "Fast" migrating hemoglobins, most commonly hemoglobins D, J, and N, can lower readings.
• Fetal hemoglobin greater than 25% interferes with hemoglobin A1c measurement and cannot be corrected for.
• True beta-thalassemia will interfere with some HPLC methods, but the patient has to be symptomatic at the time for the effect to be significant.
• Severe lipemia in some patients can interfere with measurements. Interference can be reduced by washing red cells and making an offline dilution to report out the A1C value
• Taking medications such as salicylates can have an effect, though rarely ..."

Fatty Liver Disease in Diabetes: Good and Bad?

Fatty Liver Disease in Diabetes: Good and Bad?


When the enzyme called histone deacetylase 3 (HDAC3) was removed, the mice had massively fatty livers, but lower blood sugar, and were thus protected from glucose intolerance and insulin resistance....


The findings demonstrate that fat itself is not necessarily all bad. "It matters a lot how fat is handled and stored," notes Lazar. "It also highlights the importance of complying with our internal circadian clock. For example, since our body does not anticipate food at night and is preparing to generate more glucose, night-time eating is likely to shoot up blood sugar and thus may contribute to diabetes."


The full text here.
The original article here.

Metabolic surgery for type 2 diabetes and obesity related - Nature Medicine

Metabolic surgery for type 2 diabetes

David E Cummings

Clinicians note that bariatric operations can dramatically resolve type 2 diabetes, often before and out of proportion to postoperative weight loss. Now two randomized controlled trials formally show superior results from surgical compared with medical diabetes care, including among only mildly obese patients. The concept of 'metabolic surgery' to treat diabetes has taken a big step forward.

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Topic: Guts over glory - why diets fail

Rachel Larder and Stephen O'Rahilly

Losing weight can pose a challenge, but how to avoid putting those pounds back on can be a real struggle. A major health problem for obese people is that diseases linked to obesity, such as type 2 diabetes and cardiovascular disease, put their lives at risk, even in young individuals. Although bariatric surgery[mdash]a surgical method to reduce or modify the gastrointestinal tract[mdash]was originally envisioned for the most severe cases of obesity, evidence suggests that the benefit of this procedure may not be limited to the staggering weight loss it causes. Endogenous factors released from the gut, and modified after surgery, may explain why bariatric surgery can be beneficial for obesity-related diseases and why operated individuals successfully maintain the weight loss. In 'Bedside to Bench,' Rachel Larder and Stephen O'Rahilly peruse a human study with dieters who regained weight despite a successful diet. Appetite-regulating hormones in the gut may be responsible for this relapse in the long term. In 'Bench to Bedside,' Keval Chandarana and Rachel Batterham examine how two different methods of bariatric surgery highlight the relevance of gut-derived hormones not only in inducing sustained weight loss but also in improving glucose homeostasis. These insights may open new avenues to bypass the surgery and obtain the same results with targeted drugs.

Full Text | PDF

Topic: Metabolic insights from cutting the gut

Keval Chandarana and Rachel L Batterham

Losing weight can pose a challenge, but how to avoid putting those pounds back on can be a real truggle. A major health problem for obese people is that diseases linked to obesity, such as type 2 diabetes and cardiovascular disease, put their lives at risk, even in young individuals. Although bariatric surgery[mdash]a surgical method to reduce or modify the gastrointestinal tract[mdash]was originally envisioned for the most severe cases of obesity, evidence suggests that the benefit of this procedure may not be limited to the staggering weight loss it causes. Endogenous factors released from the gut, and modified after surgery, may explain why bariatric surgery can be beneficial for obesity-related diseases and why operated individuals successfully maintain the weight loss. In 'Bedside to Bench,' Rachel Larder and Stephen O'Rahilly peruse a human study with dieters who regained weight despite a successful diet. Appetite-regulating hormones in the gut may be responsible for this relapse in the long term. In 'Bench to Bedside,' Keval Chandarana and Rachel Batterham examine how two different methods of bariatric surgery highlight the relevance of gut-derived hormones not only in inducing sustained weight loss but also in improving glucose homeostasis. These insights may open new avenues to bypass the surgery and obtain the same results with targeted drugs.

Full Text | PDF 

Stata: useful and Interesting user-written ado programs

Stata: Useful and Interesting User-written ado Programs/packages
Manage the ado programs

• Stata Syntax-highlighting for Notepad++ or download from the Notepad++ website
• Syntax Highlight Packages (Dynamic documents in Stata: MarkDoc, Ketchup, and Weaver): Synlight, Weaver, MarkDoc
• Determine build-in command or ado-file: which command
• Check codes: viewsource command or type "directory\xxx.ado"
• list of the packages: ado dir
• Install: ssc install package [,replace]
• ssc describe { pkgname | letter }: Describe a specified package at SSC
• check update: adooupdate
• update: adoupdate, update
• uninstall: ado uninstall package|[#]
• re-run profile.do: do profile.do

A list of ado packages I am using (. ssc install -package-)

• -groups- Stata module to list group frequencies. Speaking Stata (2017): Tables as Lists: The Groups Command. groups updated on SSC
• -fre- Stata module to display one-way frequency table
• -vioplot- Stata module to produce violin plots with current graphics
• -qqplot3- Stata module to plot the unweighted and weighted quantiles of one variable against the corresponding quantiles of another
• -qreg2- Stata module to perform quantile regression with robust and clustered standard errors
• -intcens- Stata module to perform interval-censored survival analysis, which is a program that fits parametric _continuous_ survival time distributions to interval-censored survival time data. The program doesn't allow
  time-varying covariates.
• -midiagplots-, a user-written ado, makes diagnostic plots for multiple imputations created by mi impute.
• -fitstat-, a user-written program is to compute fit statistics for single equation regression models.
• -mgof-, a user-written goodness-of-fit tests for the distribution/multinomial data, can deals with the survey design svy(). Jann (2008).Multinomial goodness–of–fit
• -relrank- is to generate relative data (Relative Distribution Methods in Stata)
• -svr- is a user-written program to comupte estimates with survey replication based standard errors. The -survwgt- command creates brr, jk1, jk2 and jkn replicate weights.
• -somersd- is a package to calculate Kendall's tau-a, Somers'D, AUC (Harrell's c). It can deal with the complex survey design. UCLA idre
• -st0314- Attributable and unattributable risks and fractions and other scenario comparisons (can deal with complex sampled data)
• -svylorenz-, -sumdist- Jenkins (2006): calculate Gini/Lorenz/inequality from complex survey data, summary of income distributions
• -stpm2- (slides), a extension of - stpm -, include improvement in the way time-dependent covariates are modeled; the ability to incorporate expected mortality and thus fit relative survival models; and a superior predict command that enables simple quantification of differences between any two covariate patterns through calculation of time-dependent hazard ratios, hazard differences, and survival differences. stpm has a option "left(leftvar)" to dealing with interval-censored data, and stpm2 does not have an option to deal with interval censoring (checked @ 04/016/2016, wish they could have added it).
• -tabstat- Stata module to produce and export table of results in a matricial format.
• -univar- How can I get descriptive statistics and the five number summary on one line?
• -outreg2- The 'outreg2' is based on the earlier package 'outreg' but has much more features.
• -tabout- is a table building program for oneway and twoway tables of frequencies and percentages, and for summary tables.
• -estout- How can I use -estout- to make regression tables that look like those in journal articles?
• -renvar- Stata module to rename variables
• -wridit- Stata module to generate weighted ridits
• -gtools- Faster Stata for big data. This packages uses C plugins and hashes to provide a massive speed improvements to common Stata commands.
• -ftools- A faster Stata for large datasets (Sergio's slides)
• -psmatch2- implements full Mahalanobis matching and a variety of propensity score matching methods
• -psmatch2- vs. - teffects psmatch- 

Other Resources for adding features to Stata by Stata

R Is Not Enough For "Big Data"

R Is Not Enough For "Big Data"

by Douglas Merrill

“… // Side note 1: I was an undergraduate at the University of Tulsa, not a school that you’ll find listed on any list of the best undergraduate schools.  I did pretty well at Princeton in my doctoral studies.  I’ve hired a lot of people from “bad” schools — like Washington State University — that have been very successful.  Although school is a decent proxy for intellectual horsepower, it’s only a proxy — I believe that the top 1% at any school will likely be pretty awesome.  The hard part is finding that 1%, because there’s likely a material difference between the mean of a second-rate school and the mean of a, say, Harvard. //

// Side note 3: OK, I’m about to take some real liberties with the math here, to help make my point.  All the real mathematicians out there are going to experience almost uncontrollable body twitches over the next few paragraphs.  Breathe deeply, it will pass.  //

// Side note 3: There are all kinds of mathematical problems with most regression models, notably that few things are linearly related and that many things have “correlated errors”, but I’ll leave that to Wikipedia if you’re interested. // …”

Full text here

In pursuit of scientific excellence: sex matters

In pursuit of scientific excellence: sex matters
by Virginia M. Miller
The comments of this article is from the perspective of biology, but may help us to understand existed sex/gender arguments from the perspective of public health.
"...
In the era of physiological genomics and individualized medicine, the presence of an XX or XY chromosomal complement is fundamental to the genome of an individual person, animal, tissue, or cell. Every cell has a sex.
Therefore, based on existing knowledge, it is inappropriate to assume that results from studies conducted on only one sex apply to the other (13). For some studies of neonates and embryos, cells derived from males and females are mixed in a single culture and should be reported as such. The scientific community needs to determine whether this technique is valid by providing sufficient data to control and confirm survival, differentiation, and function of cells of each sex. Similarly, cell-based therapies need to validate survival and function of the cell graft in the same- and opposite-sexed recipients.
...
How then should the sex of experimental material be reported? Use of the terms "sex" and "gender" has evolved over the last decade. According to definitions proposed by the Institute of Medicine (23), "sex" is a biological construct dictated by the presence of sex chromosomes and in animals and humans the presence of functional reproductive organs. "Gender" is a cultural construct and refers to behaviors that might be directed by specific stimuli (visual, olfactory, etc.) or by psychosocial expectations that result from assigned or perceived sex. Gender, thus, can influence biological outcomes. In most studies conducted on isolated cells, tissues can be classified as male or female by the sex chromosomal complement and for experimental animals by the sex chromosomal complement and anatomical features. Similar information may be available for humans. However, humans may self-report their sex according to gender and some studies in animals can be designed to address influences of psychosocial (gender) constructs on physiological outcomes (12). The new editorial policy for all APS journals requires the reporting of sex for cells, tissues, and experimental animals and humans (i.e., male and female) or gender where appropriate. The investigator must decide based on the experimental design which terms are most appropriate for a given study.
..."
Full text of article

In defence of white rice | BMJ

In defence of white rice
by Kadoch
The finding of an increased risk of type 2 diabetes with higher consumption of white rice1 is not surprising because suboptimal results are to be expected whenever a whole plant food is refined. This is especially true with other poor lifestyle practices. Nevertheless, I worry that we are losing the forest among the trees.
White rice has been the staple of the Asian diet for thousands of years. For most of that time it produced some of the most slender people in history. Western diseases such as diabetes and coronary artery disease were almost unheard of in this region.2 Only after the comparatively recent adoption of high fat Western dietary habits, focused primarily on animal products and highly processed junk foods, have these illnesses become more prevalent in Asia.
Diets centred on white rice have, in fact, produced some of the most dramatic health benefits reported in the medical literature. The rice diet, as pioneered by Walter Kempner, has repeatedly been shown to drastically reduce hypertension, insulin resistance, and obesity.3 Low fat diets emphasising starch have reversed diabetes and coronary artery disease.4 5 These remarkable studies were all inspired by the traditional Asian cuisine.
Encouraging patients to choose intact whole grains such as brown rice is certainly warranted. However, to rescue the Asian population from a mounting epidemic of chronic lifestyle diseases, most effort should be focused on removing the cause-the toxic Western diet. This may even justify promoting a return to white rice, instead of condemning it outright.
Full text of article